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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202659
Report Date: 07/27/2024
Date Signed: 07/27/2024 03:27:53 PM


Document Has Been Signed on 07/27/2024 03:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:LEONIE HOUSEFACILITY NUMBER:
107202659
ADMINISTRATOR:KENDAKUR, SUNDARIFACILITY TYPE:
740
ADDRESS:2931 CAESAR AVENUETELEPHONE:
(559) 347-9900
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:6CENSUS: 4DATE:
07/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Luijean De CastroTIME COMPLETED:
03:30 PM
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On 7/27/2024, Licensing Program Analysts (LPA) M. Medina conducted unannounced Annual Require inspection . LPA arrived, introduced themselves, and stated purpose of visit. LPA allowed entrance by direct care staff. Luijean De Castro, Care Coordinator contacted by telephone and arrived a short time later to conduct facility inspection.

Currently, four (4) residents in care. All residents were present at time of inspection and observed to be preparing to have lunch.

Facility toured inside and outside. Facility observed to be clean, odor free, and a comfortable temperature. Resident bedrooms toured and observed to have all required furnishings. Resident bathrooms toured, LPA observed grab bars, shower mats, and shower chair available. Water temperature measured at 110 degrees F. All common areas observed to have adequate seating available for residents in care. Kitchen toured, facility observed to have a 2-day supply of perishable and a 7-day supply of non-perishable food available. All knives observed to be locked and secured under kitchen sink. Medication observed to be locked and secured in hallway closet. Medication observed to have original labels and to be administered as prescribed.

Carbon monoxide detector and smoke detectors observed operational at time of inspection. Fire extinguisher present with a purchase date of 7/02/24.

Outside of facility toured. Exit gate is self latching. All exits open free of obstruction. Storage shed in back yard observed to be locked and secured. No hazards observed.

Staff and resident files reviewed. Administrator to submit updated LIC 9020, LIC 500 and Copy of Liability Insurance to Fresno Regional Office no later than 8/02/2024.

No deficiencies cited during inspection

Exit interview conducted. A copy of this signed report provided for facility records.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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